Supraglottic airways are an established part of routine and emergency pediatric airway management, including use in difficult airways and neonatal resuscitation. With the introduction of newer supraglottic airways in children, efficacy can only be determined by comparing these devices with those that are already well established (laryngeal mask airway Classic and laryngeal mask airway ProSeal). This narrative review aims to present the current literature on these newer supraglottic airways and give recommendations for their use in various clinical scenarios based on the existing evidence.

Purpose Supraglottic airways are commonly used as conduits for fibreoptic bronchoscopy (FOB)-guided intubation in pediatric patients. We hypothesized that anesthesiology trainees with limited prior experience with FOB-guided intubation through a supraglottic airway in children would intubate the trachea faster through the air-Q TM supraglottic airway than through the i-gel TM . Methods Ninety-six children aged one month to six years were randomized to receive either the i-gel or air-Q for FOB-guided tracheal intubation by anesthesiology trainees. Time for successful tracheal intubation was the primary endpoint. Secondary endpoints included: time for device insertion, number of attempts for successful device insertion, airway leak pressures, FOB grade of laryngeal view, total number of attempts for tracheal intubation, time for removal of the device after tracheal intubation, and associated complications. Results The median (interquartile range [IQR]) times to successful tracheal intubation for the air-Q (62.5 [47.9-77] sec) and the i-gel (55.9 [48.5-81.8] sec) were not significantly different (median difference 6.6 sec; 95% confidence interval [CI] -13.3 to 8.7; P = 0.53). The median (IQR) time to insertion for the air-Q (16.7 [14.4-20.0] sec) was shorter than for the i-gel (19.6 [16.7-23.0] sec) (median difference 2.9 sec; 95% CI 0.8 to 4.7; P = 0.005). There were no differences between devices with respect to airway leak pressures, success rates, and time to removal. Compared with the air-Q, the i-gel was associated with more problems during device removal after tracheal intubation, including breakage of the tracheal tube pilot balloon (n = 0 vs n = 13, respectively; P \ 0.001), inadvertent extubation (n = 1 vs n = 5, respectively; P \ 0.001), and difficulty controlling the tracheal tube (n = 0 vs n = 21, respectively; P \ 0.001).Author contributions Narasimhan Jagannathan, Lisa Sohn, Andrea Huang, and Luis Sequera-Ramos participated in the conception and design of the study. Narasimhan Jagannathan, Lisa Sohn, Melissa Ramsey, Andrea Huang, Amod Sawardekar, and Loryn Kromrey participated in acquiring the data. Narasimhan Jagannathan, Andrea Huang, and Gildasio S. De Oliveira participated in the analysis of the data. Narasimhan Jagannathan, Lisa Sohn, Andrea Huang, and Gildasio S. De Oliveira participated in the interpretation of the data. Narasimhan Jagannathan, Lisa Sohn, Melissa Ramsey, Luis Sequera-Ramos, and Gildasio S. De Oliveira contributed to drafting the article. Conclusions Contrary to our hypothesis, both the air-Q and i-gel supraglottic airways served as effective conduits for FOB-guided tracheal intubation in children when performed by trainees with limited prior experience. The i-gel, however, was associated with more problems during device removal following tracheal intubation. This study was registered at http://clinicaltrials.gov/show/NCT02189590. RésuméObjectif Les voies aériennes supraglottiques sont fréquemment utilisées comme conduits pour l'intubation guidée par bronchoscopie à fi...